President's Message - Time to Be Bold

by Mike Fotis, ICHP President
November 1, 2013

I would like to take a minute to thank Tom Westerkamp. Of course we all should thank him for his service to ICHP – for his commitment, patience, persistence, judgement, and good sense. Can I add a personal note of thanks? One or two of you might also know that Tom and I worked together years and years ago at Northwestern Memorial. Tom was one of those candidates who you just knew could not miss. He also was one of those special pharmacists who end up making everything better. Relations within our department as well as outside of our department improved almost immediately after he started. He was not afraid to be bold. We set out to develop clinical pharmacy services in a way that everyone, and I mean everyone, said couldn’t be done. Well Tom, as you know we did it, and I just want to make sure you know how grateful I have always been that you decided to join us at NMH. Now about 30 years later, it was a special experience for me to work together with you once again, and I certainly do look forward to continuing to work with you on the ICHP Board for another year.

It’s Time to Be Bold.

Our strengths can often be our weaknesses. This concept is described as recently as the Harvard Business Review and as far back as scriptures. For example - and every single one of us in this room has this trait - paying close attention to detail can lead us to missing the big picture. And I think at times we have. One cannot succeed as a pharmacist without paying close attention to detail. We simply need to remind ourselves this can also be a weakness and make time to consider the big picture. Pharmacists are such goody goodies. We are so careful to follow every rule and regulation. Particularly those rules set out for us by our employers. We also do everything we can to improve efficiency. Of course it is a good thing to work efficiently, and play by the rules. But one imagines that pharmacists and technicians working at some of those compounding pharmacies we have heard so much about were also working very efficiently. Sometimes efficiency is not enough. We also need to ask if what we are doing serves the proper purpose and if it is worth doing in this way. If all we do is worry about efficiency, well that’s a good way to end up on 60 minutes exercising our right to evoke the Fifth Amendment. Not the way any of us want to be seen on network TV.

As students (and even as preceptors) we learn to answer questions but not when or how to ask questions. We teach our residents, students and new practitioners to meet goals but not when or how to set goals. We all certainly can get things done, but we don’t always ask if these things are worth doing. We learn to memorize information but can too easily avoid having our own understanding of these concepts. We become highly informed about a limited body of knowledge yet remain uniformed about the rest.

Our nation is working to transform healthcare and pharmacists need to work to transform the practice of pharmacy. In order for us to formulate new directions, new ways of doing things we must have our own knowledge and understanding of every key issue, not simply repeat what is taught. 

Sometimes we need to accept and take risks for our profession. (I am not talking about putting our patients at risk.) Years ago when I was first appointed Residency Program Director I had the opportunity to attend a leadership conference at Eli-Lilly headquarters in Indianapolis. At one session we were divided into groups to play a game that required each group to plan and execute a dangerous trip by camel across the Arabian Desert. I think some of you in the room remember this game. We had to decide how much food, water, and shelter to take, and to choose a route to our destination. There was a direct route that took you right across the desert. There were indirect routes that led to a series of oasis stops where your team could replenish supplies such as food and water. Of course all of the pharmacy teams took what seemed to be the safe route going around the desert and stopping at every oasis. All of the pharmacy teams chose this method, stocking up on food and water and traveling very slowly – too slowly it turns out and we were overexposed to the desert because we were afraid to risk taking the most direct route. As you might expect, all of the pharmacy teams perished in the desert. My team was the first to perish. You needed to realize that you had to take a risk in order to survive. Take the direct route to the destination, and travel light and fast. None of the teams that played it safe survived, because the odds were stacked against you. But some of the teams that took a risk made it safely to their destination. 

I had the opportunity to participate in preparing the Pharmacy Forecast 2013-2017 published by the ASHP Foundation. While discussing the findings with colleagues, I noticed an interesting inconsistency in responses. Under technology, the predictions are bold and optimistic for progress in all areas- such as CPOE, integrated and comprehensive IT decision support, time spent, etc. Basically, the forecast predicts A-Z advances in technology. Good stuff! But I noted that in the practice model section most responses were conservative and perhaps the opposite of bold. We predict minor or no real changes in pharmacy practice. In other words, we predict the status quo. Peter Drucker had so many good quotes in his career, but one of my favorites is: "There is nothing so useless as doing efficiently that which should not be done at all."

I think if we do achieve multiple advances in technology, we had better make necessary changes to our daily practices. Fine tuning the status quo is simply not good enough. Making candles ever more efficiently does not lead one to the electric light bulb. Can we as pharmacists become bold enough to disrupt our routine and move on to a new practice model?

Our healthcare system does not always work very well. If you or a loved one has never been seriously ill or if you are a US Senator or Congressman, I can understand why you might disagree with me. For the rest of us, I believe there are too many avoidable errors, much cost inefficiency, and for the most part we leave our most vulnerable patients to fend for themselves. So many pharmacists do exceptional work to improve our health system. We need to change the way we work as pharmacists so that all of us can provide this level of care. Our patients need us to do this.

My closing advice for all of the students in the room is that in addition to everything else they are learning this year that you:

Learn when and how to ask questions;
Learn when and how to set goals;
Work with your mentors to determine if our activities are worth doing;
Have interests beyond a single area of expertise;
Help us to formulate new directions, new ways of doing things by having your own knowledge and understanding.

I want to thank the Nominations Committee and everyone here for your confidence in me. If like me you are tired of being a goody goody and want to rebel…but in a pharmacist sort of way, why, I would love to talk to you. Please introduce yourself at any time!

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